All children in YEAR 2 – YEAR 5 are invited to join in the FUN, FAITH, and FRIENDSHIP on the Following FRIDAYS 10 July & 17 July in the July school holidays from 9:00 am – 12:00 pm. Spaces are Limited. Cost: $10 per child per day. Fill in the form below to register your child.


HOLIDAY BIBLE CLUB APPLICATION FORM

Child's Name and Surname *

Parent's Name and Surname *

Address

Email Address

Phone Number *

Emergency Contact

Date of Birth *
Day : Month : Year :

Current Age *

School Year Level *

Gender *
MaleFemale

Medical Concerns or Problems
(Please give full details of any medial problems your child may have and/or any medications they may require)

Allergies
(Please give full details of any allergies you child has)

Indemnity *

Our Commitment :
Throughout the Holiday Programme we will do everything we can to maintain & monitor your child's health & safety at all times.

Indemnity :
As a parent/ guardian, I acknowledge that during the programme my child will be exposed to the obvious risks associated with programme activities. I indemnify the supervisors and leaders of First Presbyterian Church Papakura and keep them indemnified against all claims, demands and liabilities of any kind (other than due to willful negligence) arising from my child's participation in the programme.

Authorization :
I authorize First Presbyterian Church Papakura Leadership, in the event of any accident or illness involving my child/ren, to obtain such medical and hospital assistance as they believe may be necessary and agree to meet all expenses thereby incurred.

Yes I Accept

Images *

I give permission for images of my child to be used in First Presbyterian Church Papakura promotional material.

YesNo

Payment *

In order for this registration to be verified a deposit of $10 or full payment of $20 must be paid, either by Online Banking :

• Account Name : First Presbyterian Church Papakura
• Account Number : 02 0400 0019130 00
   (Use Child's First Initial and Last Name as the reference code)
• Or Drop the money into the church office on the corner of Coles Cres and Gt South   Rd Papakura.

Paid Deposit OnlyPaid in Full

 

* Required Field